Influences of pre-fracture mobility and early mobility on healthcare outcome measures in older patients undergoing hip fracture surgery

Early mobilisation (within 1-day of hip fracture surgery) improves health-related outcomes, However, the role of pre-fracture mobility has hitherto been overlooked. We postulated that both pre-fracture and early mobility independently influence patient outcome measures when admitted with hip fractures. A total of 3134 patients (71.2% women) aged 60–107 year undergoing hip fracture surgery between 01-April-2014 and 03-June-2022 were studied. Pre-fracture mobility and early mobility were regressed simultaneously in multivariable logistic models to predict outcomes and discharge destinations. Data are presented as age- and sex-adjusted odds ratios (OR) and 95% confidence intervals (CI). Compared to patients able to mobilise freely before a fracture, those who could only mobilise outdoors with two aids/frame or were limited to indoors had: a greater risk of death, OR = 1.87 (1.20–2.91); hospital stay ≥ 16days (upper quartile), OR = 1.65 (1.33–2.05); or pressure ulcers, OR = 1.91 (1.00–3.68). Also, they were more likely to require rehabilitation, OR = 1.99 (1.60–2.48) and residential/nursing care, OR = 2.26 (1.40–3.64) and less likely to return home; OR = 0.43 (0.35–0.53). Compared to patients who mobilised early within 1-day of hip fracture surgery, those unable to mobilise early had greater risk of death, OR = 4.17 (2.47–7.05); hospital stay ≥ 16days, OR = 2.05 (1.55–2.72); pressure ulcers, OR = 3.31 (1.33–8.26), and more likely to require residential/nursing care, OR = 2.95 (1.40–6.22) and less likely to return home, OR = 0.58 (0.43–0.77). Pre-fracture mobility and early mobility are independent indicators of health outcomes and level of care. Thus, both should be considered by multidisciplinary teams reviewing management and discharge planning for elderly adults undergoing hip fracture surgery.